Objective To explore the application of optical coherence tomography in vascular tissue engineering culture by dynamic monitoring its changes.Methods Human umbilical artery smooth muscle cells were isolated and culture by tissue block method.After passage culture and cell surface markers evaluation, smooth muscle cells were seeded onto polyglycolic acid scaffold and placed into the bioreactor based on Luo-Ye pump with pulsatile stress for three-dimensional culture.At 1、4、 7 、10、14、17、21 days in culture, the image data was obtained by optical coherence tomography technology.The ability of imaging TEBV via OCT was analyzed combined with histopathological observation.Results As the incubation time extended,OCT clearly showed PGA gradual degradation, decreased composite scaffold thickness and the wall structure from loose to tight.At 21 days in culture, the vessel mimics had smooth surface with extracellular matrix evenly distributed and achieved complete reconstruction in the PGA scaffold.Combining with histopathological staining, the blood vessel mimics were similar to natural blood vessels.OCT measured TEBV thickness compared with histopathological measurement had good correlation (r =0.922,P ＜ 0.05).Conclusion Optical coherence tomography could clearly image microstructures of tissue engineered blood vessels cultured in three-dimensional culture system based on Luo-Ye pump, delineate the reconstruction of TEBV-like tissue in the bioreactor and provide as a dynamic and convenient monitoring tool in vascular tissue engineering.

Objective To study the value of three-dimensional (3D) visualization and virtual surgery system in piggyback liver transplantation. Methods Two patients who suffered from choledocholithiasis were scanned by 64-slice spiral CT and the data were collected. The segmentation of the hepatic CT images was carried out. The 3D model of the liver and the intrahepatic vessels was reconstructed, and was imported to the FreeForm Modeling System in STL format for smoothing and modifying. Piggyback liver transplantation was simulated with the force-feedback equipment (PHANToM). Results The reconstructed 3D model of the liver was vivid, and the process of the virtual piggyback liver transplantation was verisimilar. Conclusions The 3D model of the liver enables the simulation of piggyback liver transplantation. It can reduce the risk and complications of the surgery, and enhance the communication between doctor and patient through designing surgical plan and demonstrating visualized operation before surgery. Virtual liver transplantation is also helpful during the training of medical workers.

Aim To establish the rat model of Spleen-Qi deficiency, analyse the metabolic pathways and investigate the connection between the changed urinary metabolites and Spleen-Qi deficiency, in order to explore the potential mechanisms of Spleen-Qi deficiency.Methods With the binding methods of diarrhea induced by bitter and cold, abnormal of starvation and excessive tiredness, the rat Spleen-Qi deficiency model was established.Then the activity of creatine phosphokinase(CPK) was detected.The endogenous metabolites in the urine were detected by NMR, and the data were analyzed with multivariate and statistical methods.Then the metabolites were selected that could be clearly distinct in the two groups with the fold change value(>1.2) and the P<0.05 of Student′s t-test.Both the pathway analysis and enrichment analysis were performed with Metabo Analyst 3.0.Results Compared with the normal rats, the activity of CPK decreased significantly in model rats(P<0.05).A significant separation appeared in the principal components analysis(PCA) score plot when the control group and the model group were compared, indicating that the Spleen-Qi deficiency model was successfully duplicated.The 33 differential metabolites, which mainly involved in the metabolic pathways, were distinguished from the comparision of Spleen-Qi deficiency model group and control group.The metabolic pathways was related to energy metabolism, amino acid metabolism, nucleotide metabolism and disturbance of gut microbes.Conclusions The main energy metabolic pathways (tricarboxylic acid cycle, glycolysis and liquid oxidation) may be disturbed in Spleen-Qi deficiency rats.The energy supply function is suppressed, which leads to the fatigue and weight loss in rats.

As a progressive and chronic intractable disease, chronic pancreatitis (CP) is generally manifested as early chronic pain, and then exocrine and endocrine insufficiency, and various complications in clinical course. The complex clinical manifestations lead to the controversies over treatment strategies at present, involving a multidisciplinary treatment (MDT) approach. It can enable different professional medical experts to discuss the diagnosis and treatment for patients together during a specific period (online or offline), which is an effective mode for diagnosing and treating complex diseases nowadays. MDT for CP usually begins with lifestyle intervention and drug therapy, and then goes with endoscopic interventions and surgical resection, or their combination. This article reviewed the current status on MDT approaches for CP and shared the MDT experience from Changhai Hospital in order to improve the management of CP course.

Objective:Based on the previous animal experiments, to preliminarily explore the safety and efficacy of self-developed new smartphone-controlled vibrating capsule (VC) in the treatment of patients with functional constipation (FC).Methods:At the Outpatient Department of Gastroenterology, Changhai Hospital, Naval Medical University, 24 patients with FC were prospectively enrolled. The trial process included basic period for ≥two weeks, treatment period for six weeks, and follow-up visits ≥six (once every two weeks). During treatment period, the patients were assigned into sham capsule group, VC at low frequency mode group and VC at high frequency mode group and the patients swallowed 12 corresponding capsules. The safety of VC treatment was evaluated based on the observation the occurrence of adverse events (AE) in patients of three groups, which included abdominal pain, abdominal distention, capsule retention and abnormal laboratory indicators. The efficacy of VC treatment was assessed by comparison of the patients of three groups in mean complete spontaneous bowel movements (CSBM) per week, mean spontaneous bowel movements (SBM) per week, capsule discharge time, patient assessment of constipation quatity of life questionnaire (PAC-QOL), patient assessment of constipation symptom questionnaire (PAC-SYM). Chi-square test, least significant difference- t test, Kruskal-Wallis test, Wilcoxon rank sum test and Fisher exact test were used for statistical analysis. Results:Two patients were lost in follow up. In the end, seven, eight and seven patients were enrolled in sham capsule group, VC at low frequency mode group and VC at high frequency mode group. AE occurred in three patients. At the sixth week of treatment, the difference between average CSBM in one week and baseline of sham capsule group, VC at low frequency mode group and VC at high frequency mode group was 0.0 (0.0, 2.0), 2.0 (1.0, 2.8) and 1.0 (0.0, 5.0), respectively; and the difference between average SBM in one week and baseline of sham capsule group, VC at low frequency mode group and VC at high frequency mode group was -1.0 (2.0, 2.0), 1.0 (-0.8, 2.0) and 1.0 (0.0, 4.0), respectively. During the six weeks of treatment period, the difference between mean CSBM per week and baseline of three, seven and five patients of sham capsule group, VC at low frequency mode group and VC at high frequency mode group was more than one, and the difference between SBM per week and baseline of two, five and five patients was more than one. At the sixth week of treatment, capsule discharge time of VC at low frequency mode group and VC at high frequency mode group was shorter than that of sham capsule group ((65.7±9.3) and (59.1±3.4) h vs. (96.7±10.0) h), and during the whole treatment period capsule discharge time of VC at low frequency mode group and VC at high frequency mode group was shorter than that of sham capsule group ((63.6±8.6) and (59.8±6.6) h vs. (100.5±13.1) h), and the differences were statistically significant ( t=3.119, 3.584, 2.832 and 3.036, all P<0.05). The PAC-SYM score of patients of sham capsule group, VC at low frequency mode group and VC at high frequency mode group during the period of treatment was 14.3±2.0, 9.9±2.3 and 7.0±2.0, respectively, there were no statistically significant differences among the three groups ( P>0.05). The PAC-QOL score of patients of sham capsule group, VC at low frequency mode group and VC at high frequency mode group during the period of treatment was 31.3±4.4, 24.0±3.8 and 13.9±4.1, respectively, and the PAC-QOL score of VC at high frequency mode group was lower than that of sham capsule group, and the difference was statistically significant ( t=2.808, P=0.012), however, there was no statistically significant difference in the PAC-QOL score between VC at low frequency mode group and sham capsule group, and between VC at high frequency mode group and VC at low frequency mode group (both P>0.05). Conclusions:VC can be safely used in patients with FC, which can promote defecation and relieve the symptoms of constipation. However, there is no significant difference in the therapeutic effect of capsules with different vibration frequencies.

Objective:To explore the clinical characteristics of intellectual developmental disorder with cardiac arrhythmia syndrome (IDDCA) in a family caused by GNB5 gene variation and to review the literature.Methods:The clinical and genetic data of an infant with IDDCA, who visited Shenzhen Children′s Hospital in September 2018, were collected and analyzed. His parents′ and brother′s gene analysis was also done by the next-generation sequencing and confirmed by Sanger sequencing. Related literature up to March 2020 was searched in Online Mendelian Inheritance in Man (OMIM), PubMed, CNKI and Wanfang databases with “GNB5” “IDDCA” “LADCI” “intellectual developmental disorder with cardial arrhythmia” “language delay and attention deficit-hyperactivity disorder or cognitive impairment with or without cardiac arrhythmia” as the key words. The related papers were retrieved and analyzed to summarize the clinical and genetic characteristics of this disorder.Results:The proband was an 11-month-old boy who presented with mental and motor developmental retardation, accompanied with convulsion and muscle weakness. Sinus arrest was also detected. His electroencephalogram (EEG) and flash visual evoked potential (FVEP) were both abnormal. Genetic analysis identified the homozygous frameshift variation of GNB5 gene (c.136delG, p.Glu46Argfs*8) in this infant and heterozygous variation in his parents, confirmed the diagnosis of IDDCA. The same GNB5 variation was identified in his brother, who was 4 years and 8 months old and had developed the similar clinical manifestations after birth. There were only 7 papers reporting this disease in the literature review, with a total of 27 patients from 14 families. Including these 2 cases, there were 29 patients in total, whose age of diagnosis ranged from 5.5 months to 23 years. Among all the patients, 20 cases (69%) were diagnosed as IDDCA, while 8 cases (28%) as LADCI; and 11 (38%) were males while 18 (62%) females. Regarding the clinical features, 66% (19/29) had mental retardation, 41% (12/29) had seizures, 79% (23/29) developed language delay and 62%（18/29） had sinus node dysfunction. Genetic tests showed that 4 patients from 3 families had complex heterozygous variation, and 25 patients (86%) from 12 families had homozygous variation. Seventeen patients from 8 families were consanguineous. Among the total 12 variations, there were 4 nonsense, 3 frameshift, 2 missense and 2 shear mutations, and 1 shear disorder caused by synonymous mutation.Conclusions:IDDCA caused by GNB5 gene variations mainly manifests as general developmental delay or severe mental retardation, and sinus node dysfunction. GNB5 associated syndromes have phenotypic heterogeneity and are inherited in an autosomal recessive manner.

Objective: To evaluate clinical efficacy and surgical techniques of customized variable-angle locking acetabular wing plates in treatment of complex acetabular fractures in the elderly through the lateral-rectus approach. Methods: Data of 11 elder patients of complex acetabular fractures (mean age 75 y, range: 60-93 y; 8 males, 3 females) admitted to our department from March 2016 to March 2017 were retrospectively analyzed. According to Judet-Letournel classification of acetabular fractures, there were 2 cases of anterior column and posterior hemitransverse fractures, 9 cases of both-column fractures. The customized variable-angle locking acetabular wing plates were designed by mimics software and then produced before surgery. During the operation, the customized variable-angle locking acetabular wing plate was applied to reduction and fixation via the anterior lataral-rectus approach. The effect of fracture reduction was assessed by Matta's criteria. The clinical effect was assessed by Harris Hip score and the modified Merle d' Aubigné-Postal score at the 6th month of postoperative follow-up. Results: The average time of designing and producing customized variable-angle locking acetabular wing plates was 4 d (3-5 d), the average operation time was 95 min (45-150 min), and the average intraoperative bleeding was 600 ml (250-1 400 ml). All patients were followed up, with an average follow-up of 18 m (6-24 m). All fractures were healed, with an average healing time of 8 weeks (6-12 weeks). Reduction quality: excellent in 8 cases, good in 2 cases, poor in 1 case, with an overall excellent and good rate of 90.9%. The result of Harris Hip scoring: excellent in 7 cases, good in 3 cases, and acceptable in 1 case, with a total excellent and good rate of 90.9%; Modified Merle d' Aubigné-Postal soring: excellent in 6 cases, good in 3 cases, and acceptable in 2 cases, with an overall excellent and good rate of 81.8%. There were 2 cases of obturator nerve injury, 1 case of fat liquefaction of incision, 3 cases of traumatic hip arthritis. During the follow-up, no complications such as ectopic ossification, plate fracture and screw loosening were found. Conclusion The customized variable-angle locking acetabular wing plates in treatment of complex acetabular fractures in the elderly via the lateral-rectus approach can achieve satisfactory reduction and firm fixtation.

Objective:To investigate the knowledge, attitude and practice of general practitioners (GPs) in Shenzhen towards managing patients with common mental health problems.Methods:It was a cross-sectional study, from September 19 to October 31, 2020, 500 GPs from 100 community health centers (CHC) in 10 districts of Shenzhen municipality were randomly selected as the research subjects by stratified random sampling; the survey was conducted by self-filled questionnaire, which included general conditions, knowledge tests of common psychological problems (generalized anxiety disorder, depressive disorder, panic attacks, sleep disorders), GPs′ attitudes to take care of common psychological problems, and GPs′ practice of caring for common psychological problems.Results:A total of 500 questionnaires were distributed and 329 valid ones were collected. In terms of knowledge, GPs had the highest accuracy of answering the characteristics of depressive disorder (97.3%, 320/329), and the lowest accuracy of case analysis of panic attacks (50.2%, 165/329). In terms of attitude, 71.1%(234/329)of GPs agreed that "common psychological problems should be taken care of",there was a statistically significant difference in attitude scores among GPs with different years of working in CHC ( Z=14.60, P=0.006). In terms of practice, the most encountered mental health problem was insomnia (91.2%, 300/329), 46.5% (153/329) of GPs would use psychological assessment scales, 52.9% (174/329) of GPs would choose direct referral, and there were statistically significant differences in attitude scores among GPs with different years of working ( Z=10.70, P=0.030) and years of working in CHC ( Z=22.14, P<0.001). Conclusions:GPs have a positive attitude in taking care of common psychological problems, but lack of knowledge and confidence. As working in CHC for more years, GPs are more inclined to care for patients with common psychological problems in practice.

Objective:To explore the feasibility of 400 mL Sprite Zero ? in gastric preparation for magnetically controlled capsule endoscopy (MCE) . Methods:A randomized controlled trial at the Department of Gastroenterology of Changhai Hospital, Naval Medical University from December 16th, 2019 to January 15th, 2020 was conducted. The patients and healthy volunteers who intended to receive MCE were randomly divided into the Sprite Zero ? (S) group and the water (W) group at 1∶1. For subjects in the W group, 800 mL water was taken 10 minutes before swallowing the capsule. And for subjects in the S group, 400 mL Sprite Zero ? was taken. The primary endpoint was gastric filling score and the secondary endpoint included the fullness score, gastric transit time (GTT), small bowel transit time (SBTT), completion rate (CR) for small bowel examination and the diagnostic yield. Results:A total of 102 subjects were enrolled, 52 subjects in the S group and 50 subjects in the W group. The median score of gastric filling was 4 at 0-5 min, >5-10 min and >10-15 min after taking the capsule in both groups, with less median liquid consumption in the S group than the W group (500 mL VS 950 mL, P<0.001). The S group showed lower median fullness score (7.0 scores VS 7.5 scores, P=0.030) and higher proportion of patients with GTT less than 30 minutes [69.57% (16/52) VS 27.59% (8/29), P=0.030] compared with the W group. The CR of small bowel examination in the S group was 100.00%, higher than that of the W group (89.66%, P=0.245). Conclusion:Compared with 800 mL water, 400 mL Sprite Zero ? can fully fill the stomach with more comfort. It has the potential to accelerate gastric emptying and improve the CR of small bowel examination, which is feasible for the gastric preparation.

Objective:To investigate the clinical, skeletal muscle pathological, and genetic characteristics of fatal infantile hypertonic myofibrillar myopathy (FIHMM).Methods:The clinical manifestations, laboratory assessments data and gene sequencing results of 10 patients diagnosed with FIHMM in Shenzhen Children′s Hospital from February 2017 to April 2021 were retrospectively analyzed.Magnetic resonance imaging (MRI) of both musculoskeletal system and the brain, and electromyogram (EMG) were performed in 3 cases, while muscle biopsy was performed in 2 cases.Results:Among these 10 cases, 1 case was from Northeast China and 1 case from East China, while the rest 8 cases were from South China.Eight of the 10 patients were male, and the other 2 cases were female.They were all born normal and not related to each other.The age of onset varied from 2 to 12 months.The main clinical manifestations for all the patients were progressive rigidity of the rectus abdominis (8 cases), neck muscles (7 cases), rectus abdominis (2 cases) and intercostal muscles (1 case), resulting in respiratory failure.Mildly to moderately elevated serum creatine kinase level was detected (436-5 804 IU/L) (reference range: 24-229 IU/L). Complex repetitive discharges can be seen in the EMG, without any myotonic potential.Muscle fiber degeneration, necrosis, and vacuolar degeneration were noted in the histopathological examination of the vastus lateralis and rectus abdominis.An abnormal red granular deposit was observed in a portion of the field of the modified Gomory Trichrome staining.Immunohistochemistry showed substantial deposition of desmin.Under the electron microscopy, the sarcomere structure of the muscle fibers was seriously disordered, with the destruction of Z-bands and the presence of granular deposits.The whole-exome sequencing identified the same homozygous variation c. 3G>A, p.Met1? of CRYAB gene in all the patients, but heterozygous variation in their parents. Conclusions:Axial muscles involvement, such as rectus abdominis rigidity, is the main clinical characteristic of FIHMM.c.3G>A, p.Met1? mutation in the CRYAB gene is a hotspot mutation in Chinese children.